Billing in Tobacco Use Disorder
- As of January 2011, Medicare covers face to face tobacco cessation counseling from a Medicare recognized practitioner (physician, physician assistant, nurse practitioner, clinical nurse specialist, qualified psychologist or clinical social worker) for all Medicare patients.
Two G codes are used for which Medicare will waive the deductible and coinsurance/copayment (Note: Routine screening is not covered):
- Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
- Short Descriptor: Tobacco-use counsel 3-10 min.
- Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
- Short Descriptor: Tobacco-use counsel >10 min.
- Two attempts per year are covered, but each attempt can take four sessions.
- Applies to services under Medicare Part A and Part B.
- Medicare part D still covers physician prescribed smoking medications (varenicline and, for some plans, nicotine nasal spray or inhaler with prior authorization, step therapy, and quantity limits).
- Inpatients are covered if tobacco use is not the primary reason for their hospitalization as long as they are alert and competent.
What Documentation to Include?
- Time spent on the counseling
- Type and quantity of tobacco used
- Counseling provided and any prescriptions/therapeutic recommendations (e.g., “Advised patient to quit and described risk of continued tobacco use”)
- A medical condition is no longer required to treat tobacco use disorder.
CPT Tobacco Cessation Codes
1. American Academy of Family Physicians. HCPCS, CPT, & ICD-9 Codes Related to Tobacco Cessation Counseling. AAFP.org. 2011.
(Available at: http://www.integration.samhsa.gov/images/res/Coding-list.pdf )
2. University of Wisconsin Center for Tobacco Research & Intervention (UW-CTRI). International Classification of Diseases (ICD) – 10 Codes Tobacco/Nicotine Dependence, and Secondhand Smoke Exposure Effective October 1, 2015. . 2015.
(Available at: http://www.ctri.wisc.edu/documents/icd10.pdf)
3. SBIRT CORE Training.
(Available at: http://www.sbirttraining.com/)
Please do post your questions or comments below.
Dr. Harvinder Singh, M.D. (Admin)
Enroll in our online course to have access to all important clinically relevant psychiatry topics in one place.